Provider Demographics
NPI:1003962945
Name:HEERMANN, KATHRYN M (OT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:HEERMANN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MANNINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-8842
Mailing Address - Country:US
Mailing Address - Phone:406-261-3278
Mailing Address - Fax:406-316-5893
Practice Address - Street 1:185 MANNINGTON ST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-8842
Practice Address - Country:US
Practice Address - Phone:406-261-0327
Practice Address - Fax:406-209-6244
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5498225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT200005323Medicaid